REACH Situation Overview: Displacement and Needs in Eastern Aleppo City, Syria

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1 REACH Situation Overview: Displacement and Needs in Eastern Aleppo City, Syria 6 September 2016 INTRODUCTION As conflict in and around Aleppo city continues, an estimated 250, ,000 people remain trapped in eastern Aleppo. 1 While the humanitarian situation has deteriorated since the escalation of conflict in early July 2016, closure of Ramouseh Road on 4 September, the last remaining access route, has resulted in the effective besiegement of eastern Aleppo. 1 Over the past two months access to Eastern Aleppo has fluctuated, resulting in intermittent access to populations in need 2. In late August, access along Ramouseh Road allowed some aid and commercial vehicles to enter the area 3, 5 and also for some parts of the population to leave. However, by the time of writing, all movement into and out of Eastern Aleppo had once again ceased. With both civilians and infrastructure continuing to be targeted in the conflict the situation of vulnerable population groups remains critical. Following previous assessments of the situation in Eastern Aleppo conducted on August 4, and August 5, this assessment marks REACH s third rapid assessment. Data was collected from 2-5 September and provides updated information on the changing humanitarian situation within eastern Aleppo. This report examines access to food, water, shelter, non-food and healthcare, as well as the priority needs and future intentions of those who remain. Data was collected through 26 qualitative interviews with Key Informants (KIs) residing in the same previously assessed neighbourhoods: Ansari, Bustan al Quaser, Kady Asker, Masken Hanano, the Kurdish area of Sheikh Maqsoud, and Tarek al Bab (see map). It was not possible to assess all affected communities within Eastern Aleppo City due to an inability to obtain information from KIs during the timeframe of the assessment. Therefore, the list of assessed areas should not be considered representative of all affected neighbourhoods and findings cannot be generalised further. Interviews were conducted with community representatives with sector-specific knowledge about their neighbourhood: local council workers, nurses, pharmacists, workers from local relief organisations teachers, shop owners, and businessmen. Given the rapidly changing situation, additional information was gathered following the closure of Ramouseh Road to ensure the assessment reflects the current situation and people s future intentions. Information presented here is currently being fed into joint Syrian INGO Forum efforts to provide an overview of the rapidly evolving situation. INTENTIONS Displacement Over the past week, movement within eastern Aleppo City has remained limited. Only a few KIs reported experiencing inward movement into their neighbourhoods during this time. Since the closure of Ramouseh road on 4 September, civilian populations in all neighbourhoods are unable to leave and movement out of eastern Aleppo has completely ceased. Similar to the last assessment, KIs estimated that if it were possible, on average up to 50% of the population would leave eastern Aleppo within the next two weeks. In Sheikh Maqsoud, populations are increasingly concerned about their welfare 90% of people in this neighbourhood are now reportedly planning to leave, compared to 50% the previous week. In all neighbourhoods, the escalation of conflict and insecurity in Aleppo City was the most commonly reported reason for wanting to leave. Other less commonly reported push factors include the loss of income; and the opening of safe routes to leave. Across assessed neighbourhoods, an acute escalation of airstrikes and civilian casualties, as well as the start of fighting on the streets within eastern Aleppo remain the key events that would reportedly trigger further population movement. Map 1: Assessed neighbourhoods of Aleppo City Eastern Aleppo areas assessed Western Aleppo areas not assessed Since the previous assessments, there has been no change to the primary reported destinations for people leaving the city. KIs indicated that populations would mostly travel to Idleb, Aleppo and Hama Governorates, specifically to communities in the sub-districts of Idleb and Dana, followed by Daret Azza, A zaz, Afrin, and As-Salamiyeh. In Sheikh Maqsoud, the population would also reportedly travel to other Kurdish areas such as Quamishli if it were feasible. The top pull factors to these areas have also remained the same: the presence of friends and relatives; the perceived safety of these areas in comparison to eastern Aleppo; and better access to income, employment and health services. 1 OCHA Syria Bi-Weekly Situation Report No September 2016; Al Jazeera, Syrian forces renew siege on rebel-held Aleppo. 5 September PDF interactive link here 2 OCHA Syria Bi-Weekly Situation Report No August OCHA Flash Update: Syria Crisis Aleppo August REACH Situation Overview: Displacement and Needs in Eastern Aleppo City, Syria 18 August, REACH Situation Overview: Displacement and Needs in Eastern Aleppo City, Syria 30 August, 2016

2 Population profiles Given the ongoing restrictions to civilian movement, the demographic composition of the remaining population in eastern Aleppo has remained the same. Family groups are most common, predominantly men and their families followed by women and their families but without their husbands. For those intending to stay in eastern Aleppo, the protection of assets and a sense of duty to their community continue to be their main reasons for doing so. In the case of Sheikh Maqsoud, the perceived restrictions of movement placed upon Kurdish communities was also reported as a reason why some members of population would remain. CURRENT HUMANITARIAN SITUATION Food and Markets The food security of populations in eastern Aleppo has been significantly affected by weeks of intermittent access, as well as by the most recent closure of Ramouseh Road and the renewed cessation of vehicles carrying commercial goods and humanitarian assistance. Although populations are commonly receiving food through local council distributions and reportedly remain able to make some use of markets, barriers to accessing food have significantly increased. Local councils are now relying on their own stocks of food to continue supporting civilians. KIs in Masken Hanano estimate that stocks may only last another 15 days, while in Tarek el Bab, Ansari, Bustan al Qaser and Kady Askar distributions may be able to continue for up to one month. People s access to markets continues to be limited by airstrikes, security concerns, damaged roads and a lack of transport. In the neighbourhoods of Ansari, Bustan al Qaser, Sheikh Maqsoud and Kady Asker, core food such as flour, eggs, milk, sugar, fruit, vegetables and cooking oil are already widely unavailable in markets, while prices for available in all neighbourhoods have increased. With the exception of Sheikh Maqsoud, KIs in all communities indicated that some markets had shut following the closure of Ramouseh Road. This is reportedly to preserve stocks, since traders will be able to demand a higher price from needy populations Average reported prices of core food and reported change over the past week (SYP) 7, 8 once food distributions cease. Since last week, the prices of basic food have increased in all neighbourhoods, with the exception of Sheikh Maqsoud, where the local council had so far been able to prevent rapid inflation through controlling market prices. The greatest increases have been in the price of bulgur and bread, on average increasing by approximately 30% across neighbourhoods in the past week. In particular, food prices in the neighbourhoods of Masken Hanano and Tarek al Bab have risen on average by 40% and 36% respectively sine the previous assessment. Due to rising fuel prices and the need to run generators to access water, people in all neighbourhoods have reportedly reduced spending on food in order to compensate, which has further limited their purchasing power amid rising prices. In all but one assessed neighbourhood, people are still able to access bread through local council distributions. The exception is Sheik Maqsoud, where people have commonly started making bread at home due prohibitively high prices and shortages of fuel and flour. Map 2: Populations with enough food stocks to last four or more days 100% More than 50% Less than 50% Access to cooking fuel also remains problematic. Nobody in Ansari, Bustan al Qaser, Kady Asker or Masken Hanano is reportedly able to cooking fuel, while less than half the population is able to do so in Tarek al Bab and Sheikh Maqsoud. Less than 50% of the population in Masken Hanano reportedly have enough food stocks to last more than a few days. In Tarek al Bab this figure was over 50% of the population, while in remaining neighbourhoods all of the population reportedly have enough food stocks to last at least four days. Ansari Bustan al Qaser Kady Asker Masken Hanano Sheikh Maqsoud Tarek al Bab Bread (1 pack) % % % % % Rice (1 Kg) % % % % % Bulgur (1 Kg) % % % % % Flour (1 Kg) % % % % Not available % 2 7 Some assessed core food were reportedly unavailable across many parts of eastern Aleppo this week. As such, comparative changes are not necessarily reflective of areas experienceing high prices last week and current unavailability. 8 $1 = 515 SYP (UN operational rates of exchange as of 1 September 2016)

3 Overall, populations in eastern Aleppo expressed growing concern about the health and wellbeing of their families in light of food shortages. Children aged less than 5 years were universally identified as the most at risk population group to a lack of food, followed by children aged 5 to 17 years and elderly people. To varying degrees, populations have reportedly adopted coping strategies to deal with the current lack of food, or in anticipation of no food entering eastern Aleppo. In all neighbourhoods, people have been reducing their food intake and parts of the population have reportedly begun consuming food stocks normally reserved for emergency situations. In addition to rationing food and consuming stocks, people in Bustan al Qaser, Kady Asker and Masken Hanano are also reducing essential non-food expenditure such as health care, heating and water, and sending family members, including children to work or beg to support the family. Water Map 3: Most common source of water Reported medical facilities functioning by neighbourhood 9 Water trucking Closed wells Main network In comparison to the previous week, increased access to the main water network was evident across certain areas of eastern Aleppo, however access to water from the network continues to be heavily dependent upon access to fuel. In Kady Asker, Ansari and Bustan al Qaser, some KIs reported that the most common source of water is currently the main network, while closed wells are also commonly used to supplement supply across eastern Aleppo. In Sheikh Maqsoud, where a large communal tank has been filled using water from the water network, the lack of fuel to run generators has limited people s capacity to pump water from the tank to their households. The reported sufficiency of available water varied across neighbourhoods assessed. In Ansari and Bustan al Qaser, KIs reported that nearly everyone was able to access sufficient water to meet household needs and did not need to resort to coping mechanisms to deal with a lack of water. However, KIs in all other neighbourhoods reported that people were reducing drinking water consumption to cope with inconsistent or inadequate supply. The situation appears to have deteriorated compared to a week ago, when the most common strategy reported was modifying practices (i.e. bathing less often). In Kady Asker, some residents were reportedly reallocating spending from other basic needs to fuel, since this was necessary for them to access water. Ansari Bustan al Qaser Kady Asker Masken Hanano Sheikh Maqsoud Tarek al Bab Facilities not functioning Facilities functioning Despite challenges related to access, water quality was not a commonly reported issue, with only two KIs in Ansari and Kady Asker reporting that some people became sick after drinking water from closed wells and the main network. Healthcare Hospitals Mobile clinics / field hospitals Over the past week, the number of functioning health facilities across eastern Aleppo remained limited, with KIs reporting no change in availability of services. Emergency evacuations for people who are critically injured and unwell have reportedly ceased since the closure of Rasmouseh Road. While WHO was able to preposition medicine GP surgeries / clinics Positive improvement Negative deterioration Informal emergency care points Change since previous week and medical supplies in late August, and some trained medical personnel reportedly entered eastern Aleppo 5, no further assistance has reportedly been received and all KIs were concerned about the shortage of supplies. The delivery prepositioned supplies did not reportedly reach the neighbourhood of Sheikh Maqsoud; rather, access to medical and permission for residents requiring treatment to leave the neighbourhood is negotiated on an ad-hoc basis at checkpoints with western Aleppo. Residents were reportedly resorting to coping strategies such as recycling used medical, using non-medical for treatment and carrying out operations without anaesthesia 3 Negative increase Positive decrease 9 Functioning does not necessarily imply full access to services or teatment by a doctor formally trained in the relevant procedure, or the use of anaesthesia or appropriate clinical equipment.

4 Most common health services needed by populations Treatment for chronic disease 2. Surgery 3. Antibiotics 4. Emergency care for accidents and injuries As in previous assessments, all KIs reported an urgent need for medical services, and a shortage of medical personnel and, affecting the capacity of health facilities to provide adequate treatment for people in need. Children aged less than five years remain the most vulnerable group at risk from a lack of health care, followed by elderly people and women aged Immediately before the closure of Ramouseh Road, medical professionals supporting facilities in assessed neighbourhoods reportedly left the area and KIs have stressed that increased strain has now been placed on remaining medical staff in their absence. Shelter and NFIs There was no reported change to the most common shelter types for host populations and IDPs in the past week. Host populations typically resided in owned or rented accommodation, while IDPs remain either in abandoned houses opened up by local councils; shared or rented homes; or collective centers. Given the ongoing targeting of civilian infrastructure and large gatherings of people, individual accommodation shelters such as houses or apartments are perceived to be safer than collective centers, and remain the preferred shelter type for all population groups. Access to NFIs has remained stable. Populations are typically able to access basic and sanitation, but cooking utensils and equipment are more difficult to acquire. A lack of on markets and prohibitively high prices have continued to prevent people from accessing NFIs. Access to fuel was an urgent concern across eastern Aleppo, due to the need for fuel to power generators to access water, and maintain the functionality of medical services. In Sheikh Maqsoud access to the main electricity network has reportedly decreased from 6 to 2 hours per day in the last week. Aid In the past week, there no vehicles were reportedly carrying aid into eastern Aleppo, although distributions by local councils continued from existing stocks. Reported access to NFIs by neighbourhood 11 Ansari Bustan al Qaser Kady Asker Masken Hanano Sheikh Maqsoud Tarek al Bab Personal Female Reported access Some reported access No reported access Household If aid were to enter and be distributed, KIs indicated that the main barrier to accessing assistance remained safety and security concerns at distribution points, particularly fear of being targeted by shelling. As such, in line with previous assessments, KIs in Masken Hanano, Sheikh Maqsoud, Kady Asker and Tarek al Bab indicated that the community would prefer distributions to be at the household or street level rather than at large distribution points, with some KIs reporting that people in their community would prefer for distributions to be conducted during the night. KIs across eastern Aleppo indicated that local councils should supervise distributions. Jerry cans / buckets Positive improvement Negative deterioration Cooking utensils / Blankets / sleeping mats Clothes / shoes HUMANITARIAN PRIORITY NEEDS Change since previous week Overall, the highest ranked priority need for populations was safety and security. Across the assessed neighbourhoods, people expressed concerns for the wellbeing of family members. This sentiment transcended across subsequently ranked priority needs; shelter, food, water and healthcare. Ranked priority needs are displayed in the table above by sector along with the average intensity ranking 12 as reported by KIs across communities Most needed does not necessarily imply unavailability. Furthermore this list is not intended to be a comprehensive list of most needed medical or services, but rather indicative of needs based on community perception 11 With ongoing distributions from local councils and organisations, changes in availability of and sanitation is expected to decrease in the near future given the recent cessation of deliveries into eastern Aleppo.

5 Summary of priority reported needs by sector 12 Priority CONCLUSION Sector specific needs 1. Shelter/NFIs Access to secure shelter for protection of civilians from security concerns Increased availability of fuel sources to enable access to water and electricity, functionality of health facilities, fuel sources for cooking food Intensity ranking 6 2. Food Access to affordable basic food in markets or through continued distributions In particular: flour, as flour, eggs, milk, sugar, fruit, vegetables and baby milk Intensity ranking 5 3. Water Improved access to safe drinking water Increased fuel to allow use of pumps to carry water to household Intensity ranking 6 4. Health Increase in quantitiy of medicines, medical personnel, and supplies Increased fuel supplies to power generators, medical equipment and ambulances Intensity ranking 4 The humanitarian situation in eastern Aleppo has been worsening since early July, and the recent closure of Ramouseh Road has left the 250, , 000 remaining civilians in a critical situation. With supplies unable to enter and people unable to leave, the situation is likely to deteriorate further unless access can be re-established. Already, remaining populations appear to have become increasingly vulnerable since the previous assessment conducted by REACH a week earlier. With vehicles unable to transport either commercial goods or humanitarian assistance to eastern Aleppo, populations are facing a lack of fuel. This has affected all humanitarian sectors, since fuel is required to run generators to access household electricity; to pump water from the main network or local wells; and to maintain the functionality of health facilities. A lack of access to cooking fuel has also affected people s ability to safely prepare food. In addition to fuel shortages, the departure of medical professionals prior to the closure of Ramouseh Road and the inability to deliver further assistance, has resulted in a lack of medicine, medical and trained personnel in eastern Aleppo. As the number of civilian causalities continues to rise, remaining health facilities are placed under increasing strain and are struggling to provide adequate treatment for populations in critical need 13. Restricted access has also led to a decrease in the availability of food across all assessed neighbourhoods. Many basic food are already unavailable in markets, while the prices of available have become prohibitively high. More vulnerable population groups have already started consuming food stocks normally reserved for emergency situations, with KIs in some communities estimating that food stocks held by local councils may be exhausted in as little as two weeks. Civilians remain concerned about the targeting of distribution points and people overwhelming indicated the need for local councils to be involved in household distributions of aid in order to mitigate barriers to access. As the humanitarian situation has continued to worsen over the past two weeks, remaining populations in eastern Aleppo are growing increasingly uncertainty about the future. The sudden and recent closure of Ramouseh Road is of particular concern as this is expected to lead to a further deterioration of the current situation. Without access or assistance, shortages of food, fuel, water and medical supplies likely to reach critical levels. With dynamics constantly changing, REACH, together with Syrian INGO Forum and partners, will continue to monitor the situation in eastern Aleppo in order to provide updated information on the needs and intentions of remaining populations. About REACH REACH facilitates the development of information tools and products that enhance the capacity of aid actors to make evidencebased decisions in emergency, recovery and development contexts. All REACH activities are conducted through inter-agency aid coordination mechanisms. For more information, you can write to our global office: geneva@reach-initiative.org. Visit and follow 5 12 Intensity ranked by KIs on a scale of 1 (lowest immediate need) to 7 (urgent need) 13 Syrian Observatory for Human Rights. 20 August PDF: interactive link here